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How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews.

PloS one
January 1, 2014
Hyun-Woo Cho et al. (8 authors)
Journal ArticleReviewSystematic ReviewHuman Study
Study Details

Study Goal

The researchers aimed to compare the evidence for traditional medicine interventions (including acupressure) in clinical practice guidelines (CPGs) with evidence from systematic reviews and meta-analyses (SR-MAs).

Results Summary

The study found that acupressure was mentioned in only one CPG but was not recommended. No SR-MAs specifically addressed acupressure, indicating a lack of current evidence for its efficacy.

Population

Not specified (general focus on East-Asian countries' health care systems).

Effective Dosage

Not available

Duration

Not specified

Interactions

None mentioned

Extracted Claims (6)
InterventionDirectionEndpointPopulationDosageImpactClaim #
acupuncture
no change
chronic low back pain (LBP)
-
-
moderately recommend
#1
acupuncture
no change
(sub)acute low back pain (LBP)
-
limited current evidence
inconclusively recommend
#2
cupping
no change
both (sub)acute and chronic low back pain (LBP)
-
-
weakly recommend
#3
manual therapy
no change
both (sub)acute and chronic low back pain (LBP)
-
-
weakly recommend
#4
moxibustion
no change
-
-
lack of evidence
cannot provide recommendations
#5
herbal medicine
no change
-
-
lack of evidence
cannot provide recommendations
#6
Abstract

OBJECTIVES: The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. METHODS: We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. RESULTS: Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. CONCLUSIONS: The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system.

Medical Subject Headings (MeSH)
Asia, EasternFemaleGuideline AdherenceHumansLow Back PainMaleMedicine, East Asian TraditionalPain ManagementPractice Guidelines as Topic
Study Links
Quality Scores
SafetyNot Assessed
Efficacy50/10
Quality75/10
Citation Metrics
Total Citations13
Citations/Year1.2
Relative Citation Ratio0.63
NIH Percentile34.2%
Research Impact Scores
APT Score0.50
Weight Score1.52
Normalized Score0.55
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